Addictions and compulsions pose, most centrally, the question of how we ought to understand our actions when they are, by common understanding, not entirely free. On the one hand, are the compelled and addicts forced to act? If so, do they force themselves, or are they forced by their psychology, or by their neurobiology? Each of these possible explanations are problematic. How do we force ourselves? Why is part of our psychology independent of "us"? What relationship is there between neurological explanations and psychological explanations? On the other hand, if the compelled and addicts are not forced to act, what accounts for their consistently bad and even self-defeating actions and for their regularly violating their own resolutions to change their actions? Such attempts to explain addiction and compulsion also shed light on ordinary actions and action explanations and on what it means for actions to be free.

The unified framework for addiction (UFA) formulated by Redish et al. is a tour de force. It uniquely predicts that there should be multiple addiction syndromes and pathways – a diversity that would reflect the complexity of the mammalian brain decision system. Here I explore some of the evolutionary and developmental ramifications of UFA and derive several new avenues for research.

ABSTRACT The list of proposed addictions has recently grown to include television, videogames, shopping, day trading, kleptomania, and use of the Internet. These activities share with a more established entry, gambling, the property that they require no delivery of a biological stimulus that might be thought to unlock a hardwired brain process. I propose a framework for analyzing that class of incentives that do not depend on the prediction of physically privileged environmental events: people have a great capacity to coin (...) endogenous reward; we learn to cultivate it, and, where it is entrapping, to minimize it, by managing internally generated appetites for it. The basic method of cultivating endogenous reward is to learn cues that predict when best to harvest the reward that has been made possible by the growth of these appetites. This hedonic management occurs in the same motivational marketplace as the instrumental planning that seeks environmental goods in the conventional manner, and presumably obeys the same laws of temporal difference learning; but these laws are no longer limiting. Furthermore, instrumental contingencies often provide the most productive structure for hedonic management as well, for reasons that I discuss; but the needs of hedonic management create incentives both to pursue instrumental goals in a suboptimal manner and to avoid noticing how the hedonic incentive affects this pursuit. The result is the apparent irrationality that is often observed in process addictions. (shrink)

Ainslie argues that our responses to the threat of our own inconsistency determine the basic fabric of human culture. He suggests that individuals are more like populations of bargaining agents than like the hierarchical command structures envisaged by cognitive psychologists. The forces that create and constrain these populations help us understand so much that is puzzling in human action and interaction: from addictions and other self-defeating behaviors to the experience of willfulness, from pathological over-control and self-deception to subtler forms of (...) behavior such as altruism, sadism, gambling, and the 'social construction' of belief. This book uniquely integrates approaches from experimental psychology, philosophy of mind, microeconomics, and decision science to present one of the most profound and expert accounts of human irrationality available. It will be of great interest to philosophers and an important resource for professionals and students in psychology, economics and political science. (shrink)

Redish et al. suggest that their failures-in-decision-making framework for understanding addiction can also contribute to improving our understanding of a variety of psychiatric disorders. In the spirit of reflecting on the significance and scope of their research, I briefly develop the idea that their framework can also contribute to improving our understanding of the pervasive problem of procrastination.

As prototypical incentive with biological meaning, food illustrates the distinction between money as tool and money as drug. However, consistent neuroscience results challenge this view of food as intrinsic value and opposite to drugs of abuse. The scarce availability over evolutionary time of both food and money may explain their similar drug-like non-satiability, suggesting an integrated mechanism for generalized reinforcers. (Published Online April 5 2006).

This paper sets out and defends an account of free action and explores the relation between free action and moral responsibility. Free action is analyzed as a certain kind of uncompelled action. The notion of compulsion is explicated in detail, And several forms of compulsion are distinguished and compared. It is argued that contrary to what is usually supposed, A person may be morally responsible for doing something even if he did not do it freely. On the basis of the (...) account of free action, It is also argued that freedom and determinism are compatible and that, Though a person is morally responsible for doing something only if he could have done otherwise, Determinism does not entail that no one ever can, In the relevant sense, Do otherwise. The concluding part of the paper suggests that, If the account of the relation between free action and moral responsibility is correct, Then the class of actions for which we bear moral responsibility is significantly wider than a great many people suppose. (shrink)

Experimental philosophers have recently begun to investigate the folk conception of weakness of will (e.g., Mele in Philos Stud 150:391–404, 2010; May and Holton in Philos Stud 157:341–360, 2012; Beebe forthcoming; Sousa and Mauro forthcoming). Their work has focused primarily on the ways in which akrasia (i.e., acting contrary to one’s better judgment), unreasonable violations of resolutions, and variations in the moral valence of actions modulate folk attributions of weakness of will. A key finding that has emerged from this research (...) is that—contrary to the predominant view in the history of philosophy—ordinary participants do not think of weakness of will solely in terms of akrasia but see resolution violations and moral evaluations as playing equally important roles. The present article extends this line of research by reporting the results of four experiments that investigate (i) the interplay between hastily revising one’s resolutions and the degree of reasonableness of the actions one had resolved to undertake, (ii) whether ordinary participants are willing to ascribe weakness of will to agents whose actions stem from compulsion or addiction, and (iii) the respects in which akratic action, resolution violations, and the seriousness of an addiction impact attributions of weakness of will to agents acting in accord with their addictions. (shrink)

Addiction is increasingly described as a “chronic and relapsing brain disease”. The potential impact of the brain disease model on the treatment of addiction or addicted individuals’ treatment behaviour remains uncertain. We conducted a qualitative study to examine: (i) the extent to which leading Australian addiction neuroscientists and clinicians accept the brain disease view of addiction; and (ii) their views on the likely impacts of this view on addicted individuals’ beliefs and behaviour. Thirty-one Australian addiction neuroscientists and clinicians (10 females (...) and 21 males; 16 with clinical experience and 15 with no clinical experience) took part in 1 h semi-structured interviews. Most addiction neuroscientists and clinicians did not uncritically support the use of brain disease model of addiction. Most were cautious about the potential for adverse impacts on individuals’ recovery and motivation to enter treatment. While some recognised the possibility that the brain disease model of addiction may provide a rationale for addicted persons to seek treatment and motivate behaviour change, Australian addiction neuroscientist and clinicians do not assume that messages about “diseased brains” will always lead to increased treatment-seeking and reduced drug use. Research is needed on how neuroscience research could be used in ways that optimise positive outcomes for addicted persons. (shrink)

‘Twelve Step' recovery programmes such as Alcoholics Anonymous teach that an alcoholic, or other addict, has a disease, and needs to accept that she is ‘powerless' over her addiction before recovery can begin. However, the disease model of addiction has been criticised on the grounds that some addicts recover without external intervention. This critique is questionable, not because such recovery does not occur, but because many genuine diseases are self-limiting. However, the disease model is better criticised on other grounds. Central (...) here is the idea of powerlessness. This article explores various supposed instances of powerlessness, including that induced by extreme fear, provocation and obsessive-compulsive disorder. It is argued that while addiction is a genuine phenomenon, it is strictly inaccurate to describe it as a lack of power. However, there is a deeper sense in which the autonomy of addicts is compromised, although this does not show that addiction is a disease. (shrink)

Redish et al. provide a significant advance in our understanding of addiction by showing that the various addictive processes are in fact all decision-making processes and each may undergird addiction. We propose means for identifying more central addiction processes. This recognition of the complexity of addiction followed by identification of more central processes would help guide the development of prevention and treatment.

Neuroscience has substantially advanced the understanding of how changes in brain biochemistry contribute to mechanisms of tolerance and physical dependence via exposure to addictive drugs. Many scientists and mental health advocates scaffold this emerging knowledge by adding the imprimatur of disease, arguing that conceptualizing addiction as a brain disease will reduce stigma amongst the folk. Promoting a brain disease concept is grounded in beneficent and utilitarian thinking: the language makes room for individuals living with addiction to receive the same level (...) of compassion and access to healthcare services as individuals living with other medical diseases, and promotes enlightened social and legal policies. However such claims may yield unintended consequences by fostering discrimination commonly associated with pathology. Specifically, the language of neuroscience used to describe addiction may reduce attitudes such as blame and responsibility while inadvertently identifying addicted persons as neurobiological others. In this paper, we examine the merits and limitations of adopting the language of neuroscience to describe addiction. We argue that the reframing of addiction in the language of neuroscience provides benefits such as the creation of empowered biosocial communities, but also creates a new set of risks, as descriptive neuroscience concepts are inseparable from historical attitudes and intuitions towards addiction and addicted persons. In particular, placing emphasis on the diseased brain may foster unintended harm by paradoxically increasing social distance towards the vulnerable group the term is intended to benefit. (shrink)

A conceptual analysis of basic notions of addictiology, i.e., Euphoria, Ecstasy, Inebriation, Abuse, Dependence, and Addiction was presented. Three different forms of dependence were distinguished: purely psychic, psycho-physiological, and purely somatic dependence. Two kinds of addiction were differentiated, i.e. appetitive and deprivative addiction. The conceptual requirements of addiction were discussed. Keeping these in mind some ethical problems of drug therapy and psychotherapy were explained. Criteria for the assessment of therapeutic approaches are suggested: effectiveness, side effects, economic, ethic, and esthetic valuation.

Individuals in managerial and professional jobs now work long hours for a variety of reasons. Building on previous research on workaholism and on types of passion, the results of three exploratory studies of correlates of work-based Passion and Addiction are presented. Data were collected in three samples using anonymously completed questionnaires: Canadian managers and professionals, Australian psychologists, and Norwegian journalists. A common pattern of findings was observed in the three samples. First, respondents scoring higher on Passion and on Addiction were (...) more heavily invested in their work. Second, respondents scoring higher on Passion also indicated less obsessive job behaviors, greater work satisfactions, and higher levels of psychological well-being. Third, respondents scoring higher on Addiction indicated more obsessive job behaviors, lower work satisfaction, and lower levels of psychological well-being. (shrink)

The authors comments on several articles on addiction. Research suggests that addicted individuals have substantial impairments in cognitive control of behavior. The authors maintain that a proper study of addiction must include a neurobiological model of addiction to draw the attention of bioethicists and addiction neurobiologists. They also state that more addiction neuroscientists like S. E. Hyman are needed as they understand the limits of their research. Accession Number: 24077921; Authors: Carter, Adrian 1; Email Address: adrian.carter@uq.edu.au Hall, Wayne 1; Affiliations: (...) 1: The University of Queensland, Brisbane, Australia; Subject: EDITORIALS; Subject: ADDICTIONS; Subject: BEHAVIOR; Subject: HYMAN, S. E.; Subject: NEUROBIOLOGISTS; Subject: NEUROSCIENTISTS; Number of Pages: 3p. (shrink)

Impaired control over drug use is a defining characteristic of addiction in the major diagnostic systems. However there is significant debate about the extent of this impairment. This qualitative study examines the extent to which leading Australian addiction neuroscientists and clinicians believe that addicted individuals have control over their drug use and are responsible for their behaviour. One hour semi-structured interviews were conducted during 2009 and 2010 with 31 Australian addiction neuroscientists and clinicians (10 females and 21 males; 16 with (...) clinical experience and 15 with no clinical experience). Although many addiction neuroscientists and clinicians described uncontrolled or compulsive drug use as characteristic of addiction, most were ambivalent about whether or not addicted people could be said to have no control of their drug use. Most believed that addicted individuals have fluctuating levels of impaired control over their drug use but they nonetheless believed that addicted persons were responsible for their behaviour, including criminal behaviour engaged in to fund their drug use. Addiction was not seen as exculpating criminal behaviour but as a mitigating factor. (shrink)

Defining brain mechanisms that control and adapt motivated behavior will not only advance addiction treatment. It will help society see that addiction is a disease that erodes free will, rather than representing a free will that asks for or deserves consequences of drug-use choices. This science has important implications for understanding addiction's comorbidity in mental illness and reducing associated public health and criminal justice burdens.

The author comments on the article “The neurobiology of addiction: Implications for voluntary control of behavior,‘ by S. E. Hyman. Hyman suggests that addicted individuals have substantial impairments in cognitive control of behavior. The author states that brain and neurochemical systems are involved in addiction. He also suggests that neuroscience can link the diseased brain processes in addiction to the moral struggles of the addicts. Accession Number: 24077919; Authors: Charland, Louis C. 1; Email Address: charland@uwo.ca; Affiliations: 1: University of Western (...) Ontario, Talbot COllege, London, Ontario; Subject: EDITORIALS; Subject: ADDICTIONS; Subject: BEHAVIOR; Subject: HYMAN, S. E.; Subject: NEUROCHEMISTRY; Subject: NEUROSCIENCES; Number of Pages: 2p. (shrink)

Heroin prescription involves the medical provision of heroin in the treatment of heroin addiction. Rudimentary clinical trials on that treatment modality have been carried out and others are currently underway or in development. However, it is questionable whether subjects considered for such trials are mentally competent to consent to them. The problem has not been sufficiently appreciated in ethical and clinical discussions of the topic. The challenges involved throw new light on the role of value and accountability in contemporary discussions (...) of mental competence. (shrink)

The author comments on the article “The neurobiology of addition: Implications for voluntary control of behavior,‘ by S. E. Hyman. The author agrees with Hyman that debate persists whether addiction is a brain disease or a moral condition. The author suggests that even if we understand the neurobiology of addiction, it will make sense to seek accountability from the addict and to modify his behavior. He also suggests that no facts about neurobiology will change these moral requirements. Accession Number: 24077917; (...) Authors: Cochrane, Thomas I. 1; Email Address: tcochrane@partners.org; Affiliations: 1: Harvard Medical School; Subject: EDITORIALS; Subject: ADDICTIONS; Subject: NEUROBIOLOGY; Subject: BEHAVIOR; Subject: HYMAN, S. E.; Number of Pages: 2p. (shrink)

The author comments on the article “The neurobiology of addiction: Implications for voluntary control of behavior,‘ by S. E. Hyman. The author agrees with Hyman that debate persists whether addiction is a brain disease or a moral condition. The author states that Hyman has not fully answered the question of when addicted persons are responsible for what they do. The author also suggests that addiction is a brain disease and therapy can improve the symptoms of this life-threatening syndrome. Accession Number: (...) 24077918; Authors: Cohen, Peter J. 1; Email Address: ccohenp@aol.com; Affiliations: 1: Georgetown University Law Center; Subject: EDITORIALS; Subject: ADDICTIONS; Subject: BRAIN -- Diseases; Subject: SYNDROMES; Subject: HYMAN, S. E.; Number of Pages: 3p. (shrink)

There are many ways of interpreting the behaviours related to substance misuse and addiction, which can be sort out as three basic models: biomedical, legal, and social. They are corresponding to approaches built in different epistemic and professional frameworks, such as medicine, law, and social work. Confronted with the experience of addiction, these models appear as pre-determined by a specific scientific or professional ideology; they presuppose a pre-understanding of the phenomena. I directed, therefore, my investigation on those phenomenological paths that (...) might lead to, and circumscribe the experience of addiction and I propose an analytical framework based on three major phenomenological perspectives: descriptive, genetic, and inter-relational. This paper argues in favour of defining addiction without making reference to a form of failure, psycho-somatic or existential. On the contrary, it concludes that there is a need to adopt a definition of addiction which holds at its core the idea of empowering addicted persons, of re-constructing their capacity to take decisions about their own lives. (shrink)

Herbert Fingarette [1] argues that alcoholism is not a disease and that the alleged alcoholic under certain circumstances has the power to control his or her drinking disorders. I shall analyze Fingarette's argument and show that his position rests on some logical and conceptual confusions.In analyzing Fingarette's argument for the self-control theory of drinking disorders I conclude that it is problematic for the following reasons: (1) his argument assumes that the identification of a single cause of alcoholism is a necessary (...) condition of its being a disease; (2) unless it is already assumed (a priori) that persons with drinking disorders possess freedom and self-control to the extent that Fingarette assumes they do, then such persons are likely to suffer from apathy or defeatism regarding their condition; (3) even if Fingarette is correct in his criticism of certain health care programs for those with drinking disorders, it does not follow from this that certain theories about the possible causes of such disorders are false; (4) Fingarette's claim that those with drinking disorders are morally responsible for their actions that result from their disorders is problematic, that is, unless it can be shown that such persons act freely; and (5) Fingarette attempts to support the self-control theory of alcoholism by refuting a straw man conception of the disease model of alcoholism. (shrink)

I show that Pickard’s argument against the irresistibility of addiction fails because her proposed dilemma, according to which either drug-seeking does not count as action or addiction is resistible, is flawed; and that is the case whether or not one endorses Pickard’s controversial definition of action. Briefly, we can easily imagine cases in which drug-seeking meets Pickard’s conditions for agency without thereby implying that the addiction was not irresistible, as when the drug addict may take more than one route to (...) go meet her dealer. (shrink)

In this paper, we contend that the psychology of addiction is similar to the psychology of ordinary, non-addictive temptation in important respects, and explore the ways in which these parallels can illuminate both addiction and ordinary action. The incentive salience account of addiction proposed by Robinson and Berridge (1993; 2001; 2008) entails that addictive desires are not in their nature different from many of the desires had by non-addicts; what is different is rather the way that addictive desires are acquired, (...) which in turn affects their strength. We examine these “incentive salience” desires, both in addicts and non-addicts, contrasting them with more cognitive desires. On this account, the self-control challenge faced by addicted agents is not different in kind from that faced by non-addicted agents – though the two may, of course, differ greatly in degree of difficulty. We explore a general model of self-control for both the addict and the non-addict, stressing that self-control may be employed at three different stages, and examining the ways in which it might be strengthened. This helps elucidate a general model of intentional action. (shrink)

Free agency and moral responsibility are incompatible with causal determinism because causal determinism, properly understood, entails that originating conditions beyond the agent's control ultimately compel all human choices and actions. If causal determinism is true, then causal antecedents and laws of nature nomologically necessitate all deliberation, choice and action. If conditions beyond the agent's control ultimately compel the agent's behaviors, then the agent is not free and is not morally responsible. Compatibilists claim that externally compelled acts are not free, but (...) fail to recognize that causally determined acts are, ultimately, externally compelled. (shrink)

Philosophers and psychologists have been attracted to two differing accounts of addictive motivation. In this paper, we investigate these two accounts and challenge their mutual claim that addictions compromise a person’s self-control. First, we identify some incompatibilities between this claim of reduced self-control and the available evidence from various disciplines. A critical assessment of the evidence weakens the empirical argument for reduced autonomy. Second, we identify sources of unwarranted normative bias in the popular theories of addiction that introduce systematic errors (...) in interpreting the evidence. By eliminating these errors, we are able to generate a minimal, but correct account, of addiction that presumes addicts to be autonomous in their addictive behavior, absent further evidence to the contrary. Finally, we explore some of the implications of this minimal, correct view. (shrink)